Stroke：脑出血患者是否应该服用他汀类药物？

2015-06-16 大鹏 cmt

有关ICH患者使用他汀类药物一直存在争议。近期，美国心脏学会和美国卒中学会(AHA/ASA)于《卒中》(Stroke)杂志发布了新版脑出血(ICH)管理指南，或许该指南相关内容能初步解答上述问题。在预防ICH复发方面，指南推荐，尚缺乏足够证据限制ICH患者服用他汀类药物(Ⅱb，C)。以下为该指南制定此项指导意见的相关证据。 SPARC

有关ICH患者使用他汀类药物一直存在争议。近期，美国心脏学会和美国卒中学会(AHA/ASA)于《卒中》(Stroke)杂志发布了新版脑出血(ICH)管理指南，或许该指南相关内容能初步解答上述问题。在预防ICH复发方面，指南推荐，尚缺乏足够证据限制ICH患者服用他汀类药物(Ⅱb，C)。以下为该指南制定此项指导意见的相关证据。

SPARCL研究显示，大剂量阿托伐他汀可以降低缺血型卒中的复发，但这种治疗收益的一部分会被升高的ICH风险所抵消。二次分析结果显示，他汀治疗、老龄及ICH疾病本身均是后期出现ICH的相关风险因素。

另一方面，一项涉及31项临床试验共纳入91588例接受他汀治疗患者的meta分析结果显示，ICH与他汀治疗之间无显著相关性(OR值为1.08，P=0.47)，而且他汀治疗显著降低了所有卒中发生率及全因死亡率。

另有研究者采用马克夫(Markov)分析法分析了既往ICH患者接受他汀治疗的利弊，其结论为，如果他汀确实升高了ICH风险，可以考虑避免他汀治疗，这点对于脑叶出血患者尤其重要。与这些研究相似的结论是，他汀治疗及患者年龄与ICH患者微出血病灶的出现及其数量(尤其是患者大脑皮质部)独立相关。

与上述结论相反，小型回顾性研究显示，ICH患者继续用他汀治疗与其早期神经系统改善及6个月死亡率降低有关。另外，目前尚无数据证实他汀治疗出现的ICH倾向性是否是呈剂量依赖性。

综上所述，有关ICH患者是否接受他汀治疗尚有争议，因此，新指南专家组延续了原指南内容。

原始出处：

J. Claude Hemphill III, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage.Stroke. Published online before print May 28, 2015,doi:10.1161/STR.0000000000000069

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#插入话题

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2015-09-05 ms6390871039024434

#他汀类药#

63 0
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2015-07-05 qing1231990

ICH患者应该还是要服用他汀类药物

170 0
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2015-06-29 owlhealth

需要好好研究

145 0
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2015-06-25 huaxipanxing

看看

191 0
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2015-06-16 chenhui888

观

170 0
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2015-06-16 owlhealth

需要看看原文和入选的试验

133 0
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2015-06-16 qinweihan19

复杂

120 0

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Stroke：脑出血患者是否应该服用他汀类药物？

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